| NPI | 1730163965 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 173000000X Legal Medicine (Licence: CA A50551) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA A50551) |
| Enumeration Date | 2005-12-01 |
| Last Update Date | 2020-08-25 |